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Key points
- To improve client outcomes, therapists use key skills to promote growth within the therapeutic alliance.
- Eight key skills are supported by research and can improve with practice.
- Even brief encounters can make a difference collaboration from a place of genuine loving-kindness.
It may seem like finding a good therapist is left largely up to fate; however, there are some consistent predictors of positive therapy outcomes that effective therapists practice. Good therapy includes a true partnership, a collaboration with someone who has the intention to alleviate suffering and facilitate healing and growth.
Miller and Moyers (2021) have compiled extensive research about positive client outcomes with eight core ingredients. All eight have an underlying core quality of compassionate beneficence. This “active ingredient” of therapy is described as a collaborative relationship that works toward agreed-upon goals with compassion and commitment. It means truly partnering with a client to connect with and elicit their inherent expertise and wisdom about their own lives. It emphasizes that skillful therapy is only effective when grounded in a place of genuine loving-kindness. They state, “What engages therapists is not usually the mastery of particular techniques, but the privilege of relating to people at a level of depth and intimacy well beyond ordinary social discourse.”1
Loving-kindness may sound hard to measure, but here are the eight identifiable skills that can be measured, learned, and practiced for better client outcomes.
1. Accurate empathy. This includes empathetic listening that converges with the client’s experience that is authentically expressed to support client self-exploration. In a meta-analysis of 82 studies with over 6,000 individuals, accurate empathy was found to be the most consistent therapeutic factor that predicts positive client outcomes.2
2. Acceptance. Acceptance is the ability to listen without preconceptions, prejudgment, condemnation, or disapproval. The inherent worth of an individual is assumed in the therapeutic alliance. Trust is placed in the wisdom that people change when they feel understood, feel the possibility of change, and when they are working from their freedom of choice. People are less likely to change just because they feel bad enough.3
3. Positive regard. Carl Rogers described unconditional positive regard as being necessary for healing. This means it is the therapist’s privilege to witness the client’s intimate experiences and there is no need to earn the therapist’s respect. Positive regard elicits the client’s wisdom, strength, focus, and growth potential.
4. Genuineness. Genuineness means the therapist is authentic, not hiding themselves from the client (and include appropriate self-disclosure). In addition, genuineness includes self-acceptance by the therapist of themselves as well.
5. Focus. Progress is more likely when there are clear goals that are agreed upon in therapy. These decisions are made collaboratively and continually modified.
6. Hope and expectation. There is ample evidence that the beliefs of the therapist influence outcomes for the client. Optimism, when it's genuinely cultivated, can directly influence outcomes.
7. Evocation. A client is more likely to change if they hear themselves say their own inherent desire to change rather than being told to do so. The questions asked during therapy are important and can increase self-efficacy to change.
8. Offering information and advice. Too much advice can backfire and feel less collaborative. It is important to honor a client’s autonomy and find out what they know already. Psychological reactance is a common response when someone does the opposite of what is recommended even if they agree with the advice given. Asking permission to give advice can help mitigate this effect.
These skills, when practiced and delivered authentically within a strong working alliance, predict positive gains for clients. Evidence of this effectiveness can be detected as early as the first session. A genuinely positive encounter—however brief—can lead to positive gains for clients and perhaps anyone else we meet.
To find a therapist, please visit the Psychology Today Therapy Directory.
References
1. Miller, W. & Moyers, T. (2021). Effective Psychotherapists: Clinical Skills That Improve Client Outcomes. The Guilford Press.
2. Elliott, R., Bohart, A. C., Watson, J. C., & Murphy, D. (2018). Therapist empathy and client outcome: An updated meta-analysis. Psychotherapy (Chicago, Ill.), 55(4), 399–410.
3. Strupp, H. (1960). Psychotherapists in action: Explorations of the therapist’s contribution to the treatment process. New York: Grune & Stratton.
4. Erekson, D.,Clayson, R., Park, S., & Tass, S. (2020) Therapist effects on early change in psychotherapy in a naturalistic setting, Psychotherapy Research, 30:1, 68-78.
